Q.1
Based on his eGFR and ACR, what categories of CKD risk does Thomas have?

Moderately to severely decreased GFR and severely increased albuminuria. According to the 2012 KDIGO guidelines, an eGFR of 30–34 is moderately to severely decreased and an albuminuria level of >300 mg/g is severely increased7

Q.2
In patients with CKD, it is essential to minimise the stress on remnant nephrons. Which of the following are important for Thomas to avoid?

It is important for Thomas to avoid nephrotoxins, urinary outflow obstructions and smoking-related cardiovascular disease

Q.3
Thomas is showing signs of macroalbuminuria, which treatment class would be recommended to delay CKD progression according to the 2020 KDIGO guidelines?

SGLT2i. Treatment with an SGLT2 inhibitor is recommended in most patients with an eGFR of ≥30 mL/min/1.73 m2, diabetes, and CKD5

Q.4
Which two treatments were shown to provide nephroprotective benefits in patients with CKD, with or without co-morbid diabetes, in the CREDENCE and DAPA-CKD trials?

Canagliflozin and dapagliflozin were assessed in the CREDENCE and DAPA-CKD trials, respectively13,14

Q.5
Thomas has no history of diabetes, which of the following treatments are approved by the EMA and FDA for patients with CKD without diabetes?

Dapagliflozin became the first SGLT2i to receive approval by the EMA and FDA for the treatment of adults with chronic kidney disease with or without diabetes15,16

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